Provider Demographics
NPI:1346815248
Name:ATAALLA, MARIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:ATAALLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 AVENUE E
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6446
Practice Address - Country:US
Practice Address - Phone:201-471-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2025-08-08
Deactivation Date:2022-11-14
Deactivation Code:
Reactivation Date:2025-08-04
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02909400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist